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Has H5N1Wild Bird Flu Recombined in Israel to Form S227N?
November 25, 2005
The Health Ministry announced Thursday that contrary to an earlier announcement it is possible that an Israeli man hospitalized Saturday at Rebecca Sieff Hospital in Safed may have contracted a virulent strain of the bird flu virus. The man's blood will be further tested both in Israel and England, the ministry said.
On Tuesday the Health Ministry reported that it was examining suspicions that a 57-year-old Galilee resident, hospitalized since the weekend, had contracted bird flu. The man was employed at the Lake Hula nature reserve and his job was to feed the birds there. A test on saliva taken from his pharynx showed that he did not carry the virus, but on Thursday it was revealed that his blood tests raised suspicions that he had the disease, and had probably contracted a virulent strain of the virus.
The above comments suggest that the 57 year old patient has contracted H5N1. A positive H5 antibody at this early date is an indication of significant antibody. If the titer increases four fold, the data will represent confirmation of H5, which would be the first confirmed H5N1 human case outside of Asia.
Although Israel has not reported H5N1 in birds, H5N1 has been reported in OIE reports from Turkey, Romania, and Croatia. Although there have been many reports of dying birds in the Middle east, media reports indicate only Kuwait has confirmed H5N1 in a wild bird (see map).
H5N1 is expected in Israel. H5N1 in wild birds was widely detected in Siberia over the summer. The positive birds were in migratory flight paths that go from Siberia to the Caspian and Black seas in the fall and then to Africa for the winter. During the migration from Europe to Africa, 500 million wild birds fly over Israel and adjacent countries.
H5N1 infections in Isael are of particular concern because H9N2 isolates in Israel contain donor sequences to create S227N in HA. This polymorphism increases HA affinity for human receptors, which would be associated with more efficient transmission to humans. Moreover, all H5N1 wild bird sequences of PB2 contain E627K, which has been associated with increased virulence in mammals as well as the ability to grow the 34 C. The ability of H5N1 to grow at the lower temperature would also increase the efficiency of transmission to the upper respiratory tract.
Thus, it would be useful to test contacts of the patient to identify additional positives and isolate the H5N1 for sequencing. Detection of HA S227N would represent a serious increase in the efficiency of H5N1 to infect humans.